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HomeWeekly RoundupSA's medical aids won't have to pay out for 'gaming disorder'

SA's medical aids won't have to pay out for 'gaming disorder'

Medical aids in South Africa will not have to provide cover for “gaming disorder” when the World Health Organisation (WHO) releases its latest International Classification of Diseases (ICD), the Council for Medical Schemes (CMS) in South Africa is quoted in a MyBroadband report as saying.

The WHO recently included gaming disorder in the latest draft of the ICD, but this won’t be implemented in South Africa for several years. Even after it is implemented, though, medical schemes in South Africa wouldn’t be required to cover treatment for gaming addiction under the current regime of legislation.

“Most medical schemes are currently only funding mental health conditions that are included in the Prescribed Minimum Benefit regulations,” CMS clinical unit senior manager Dr Olurotimi Modupe, is quoted in the report as saying. “Habit and impulse disorders are not included, and as such will not be funded by medical schemes.”

Modupe added, however, that it is important to note there have been legislative changes which may affect how conditions are covered in future. “A Comprehensive Service Package has been proposed in the Medical Schemes Amendment Bill that was released for public comments recently.”

South Africa is also gearing towards a universal health coverage system. This is to ensure access to quality health care for citizens, irrespective of socio-economic status. “This may affect how services are purchased, offered, and funded,” Modupe said in the report. For this reason, the CMS can’t predict whether or how gaming disorder may be covered in future.

Modupe explained that the draft ICD which lists “gaming disorder” is the eleventh revision of the document. While the ICD–11 mortality and morbidity statistics coding system was launched on 18 June 2018, it will only be implemented in South Africa on 1 January 2022. Until then, South Africa will continue to use ICD–10.

“It is important to remember that the ICD–10 and ICD–11 are both an International Statistical Classification of Diseases and Related Health Problems. As such, each diagnosis and disease may not have its own code,” said Modupe. “Although the current ICD–10 coding list does not have a specific code for gaming disorders, it can still be coded.”

The report says gaming addition is classified as a habit and impulse disorder, and therefore has the following ICD10 codes: F63.8 Other habit and impulse disorders; and F63.9 Habit and impulse disorder, unspecified.

“In terms of funding obligations, medical schemes are expected to fund evidence-based, cost-effective, and affordable health care,” said Modupe. “Health care decisions require considerations of costs and benefits, economic evaluation is essential for this purpose. Therefore, funding for the diagnosis, treatment, and care of the condition will have to be in line with these principles.”

The report says Modupe explained that medical schemes do not have to fund all conditions, diseases, and disorders, but must state in their rules what the minimum benefits are.

Regarding treatment for addiction to gaming, Modupe said the health care practitioners who make the diagnosis should be able to refer patients to the relevant centres for rehabilitation. “A multidisciplinary team approach is usually recommended to manage mental health disorders,” said Modupe. “All psychiatrists and clinical psychologists will be able to treat gaming addiction, as the same principles and treatment protocols as for other addictions apply.”

All registered mental health facilities will also be able to admit patients on a voluntary basis. “Unfortunately, few mental health facilities currently have involuntary beds available. Involuntary treatment for addiction or habit and impulse disorders are also not very successful,” said Modupe.

 

Meanwhile, the WHO has recognised "compulsive sexual behaviour" as a mental disorder, but said it remained unclear if it was an addiction on a par with gambling or drug abuse, reports The Times. The contentious term "sex addiction" has been around for decades but experts disagree over whether the condition exists.

The report says in the latest update of its catalogue of diseases and injuries around the world, the WHO takes a step towards legitimising the concept, by acknowledging "compulsive sexual behaviour disorder" (CSBD), as a mental illness. But the UN health body stops short of lumping the condition together with addictive behaviours like substance abuse or gambling, insisting more research is needed before describing the disorder as an addiction. "Conservatively speaking, we don't feel that the evidence is there yet … that the process is equivalent to the process with alcohol or heroin," said WHO expert Geoffrey Reed.

In the update, the WHO said CSBD was "characterised by persistent failure to control intense, repetitive sexual impulses or urges … that cause marked distress or impairment". But it said the scientific debate was still ongoing as to "whether or not the compulsive sexual behaviour disorder constitutes the manifestation of a behavioural addiction".

Reed said it was important that the ICD register, which is widely used as a benchmark for diagnosis and health insurers, includes a concise definition of compulsive sexual behaviour disorder to ensure those affected can get help. "There is a population of people who feel out of control with regards to their own sexual behaviour and who suffer because of that," he said pointing out that their sexual behaviour sometimes had "very severe consequences." "This is a genuine clinical population of people who have a legitimate health condition and who can be provided services in a legitimate way," he said.

The report says it remains unclear how many people suffer from the disorder, but Reed said the ICD listing would likely prompt more research into the condition and its prevalence, as well as into determining the most effective treatments. "Maybe eventually we will say, yeah, it is an addiction, but that is just not where we are at this point," Reed said.

But even without the addiction label, he said he believed the new categorisation would be "reassuring", since it lets people know they have "a genuine condition" and can seek treatment.

The report says claims of "sex addiction" have increasingly been in the headlines in step with the #MeToo movement, which has seen people around the world coming forward with allegations sexual mistreatment. The uprising has led to the downfall of powerful men across industries, including disgraced Hollywood mogul Harvey Weinstein, who has reportedly spent months in treatment for sex addiction.

Reed said he did not believe there was reason to worry that the new CSBD listing could be used by people like Weinstein to excuse alleged criminal behaviours. "It doesn't excuse sexual abuse or raping someone … any more than being an alcoholic excuses you from driving a car when you are drunk. You have still made a decision to act," he said.

The document, which member states will be asked to approve during the World Health Assembly in Geneva next May, will take effect from 1 January, 2022 if it is adopted.

[link url="https://mybroadband.co.za/news/gaming/267661-medical-aids-in-south-africa-wont-have-to-cover-gaming-addiction.html"]MyBroadband report[/link]
[link url="http://www.who.int/health-topics/international-classification-of-diseases"]World Health Organisation’s International Classification of Diseases (ICD-11) report[/link]
[link url="https://www.timeslive.co.za/sunday-times/lifestyle/health-and-sex/2018-07-16-who-declares-compulsive-sexual-behaviour-disorder-is-a-mental-illness/"]The Times report[/link]

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